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The article by Kunutsor et al.1 evaluated the correlation between sauna bathing patterns and risk of stroke. The study population was made up of healthy elderly people without a known history of stroke, at an average (SD) age of 62.7 (6.5) years. People at this age, especially accompanied with other cerebrovascular risk factors, are very likely to have major cervical or intracranial vessel stenosis.2,3 In the event of a heated situation such as sauna, hypoperfusion or even ischemic stroke may be induced due to large fluid loss and severe vessel stenosis.4 People with or without vessel stenosis could have a different intracranial hemodynamic correlation with sauna bathing. It is understandable that vascular evaluation may be difficult to achieve, as the research is a community-based study. However, the status of intracranial vasculature, which could be an important variable of the relationship between sauna and risk of stroke, should be included into the analysis.
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Author disclosures are available upon request (journal{at}neurology.org).
- © 2019 American Academy of Neurology
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